During the COVID-19 pandemic, telehealth has proven its value as a viable (and vital) healthcare alternative to traditional in-office visits. As telehealth continues to transform the healthcare landscape post-public health emergency, providers should begin shifting their thinking from short-term crisis health delivery to ensuring the long-term effectiveness and sustainability of such programs. To do this, health systems need to develop and implement robust performance monitoring systems, ensuring that high-quality telehealth services are delivered efficiently, affordably and effectively to patients and other stakeholders.
All successful telehealth programs leverage data to evaluate program performance and outcomes. Before an organization deploys a program, it should consider which data points are most essential in relation to the organization’s goals.
Typically, such data will fall within one of four pillars: performance, affordability, quality of outcomes and quality of service delivery. Defining key performance indicators (KPIs) that effectively address these crucial areas is the first step toward establishing a sustainable telehealth program.
Pillar 1: Performance
The category of performance encompasses those factors relating to provider productivity and effectiveness. One such critical KPI is the measure of relative value units (RVU), which is a measure of provider productivity and weighted level of effort.
Anecdotally, the telehealth format has demonstrated superior performance versus traditional in-office visits across several metrics. Physicians should be able to see more patients via telehealth versus in-person visits due to the elimination of time it takes for exam room turnover and because of streamlined patient-intake procedures. In addition, since patients are able to attend telehealth appointments from the comfort of their homes or offices, they are more apt to arrive on time as compared with in-office visits, as they don’t have to arrange for childcare, take time off work or deal with traffic on the way to the appointment.
Other key measures of performance include the connectivity of the underlying technology, the levels of examination that can be performed effectively over video (or audio), and the length of call queues and patient wait times. Dropped calls and video feeds present a real challenge in this medium, especially for providers and patients in rural and lower-income regions with limited access to broadband. Even when a call is not dropped completely, poor video connectivity can force telehealth visits to transition from full audiovisual to audio-only mid-appointment, disrupting the flow of the visit and sharply reducing outcome effectiveness.
Pillar 2: Affordability
Another key measure of success is the relative cost or affordability of telehealth versus in-person visits. In the current environment, many patients pay a flat out-of-pocket rate per telehealth appointment. In a world of high deductible health plans, the affordability of telehealth is no incidental matter, particularly for behavioral health visits, which tend to be regular, frequent and continuous over months or years.
During the public health emergency, the Centers for Medicare & Medicaid Services has expanded the numbers and types of services healthcare providers can offer through telehealth and has increased the reimbursement rates for such services. Commercial payers have rapidly followed suit. While it is uncertain how these rates may change post-crisis, affordability and coverage will continue to be important factors in evaluating the sustainability of any telehealth program.
Pillar 3: Quality of Outcomes
Of course, patient outcomes are one of the most important metrics to track in any health program, whether telehealth or in-person. KPIs that fall under this category include rates of readmission; whether a patient’s problem is solved on the first visit; the need for follow-up telehealth or in-person appointments; whether the physician is able to fully and accurately assess, diagnose and resolve the patient’s medical concern during the visit; and whether the provider spent sufficient time with the patient to provide quality care. According to J.D. Power’s second annual Telehealth Satisfaction Study, at least 69% of survey respondents considered and tracked these outcome-focused performance indicators.
Increased frequency and availability of telehealth visits may result in more effective monitoring of recurring conditions and better disease management. This seems to be true for behavioral and mental health engagements as well as those addressing chronic physical health conditions.
Pillar 4: Quality of Experience
Last, the quality of the patient and provider experience are critical but often discounted measures of telehealth effectiveness. According to the same J.D. Power survey, KPIs that measure patient satisfaction and quality of experience, including the provider’s ability to listen carefully to the patient’s needs, explain things clearly, and treat the patient with courtesy and respect, are tracked by fewer than two-thirds of survey respondents.
Measurement + Education Leads to Improvement
Defining and tracking the right data is critically important for creating a successful telehealth program. Tracking and trending results and providing feedback to providers is key to ensuring that programs are moving in the right direction and positively influencing changes in clinical practices.
Use of daily huddles where staff and providers review program performance through the utilization of dashboards is an effective mechanism to achieve continuous improvements and to realize program goals.
Telehealth is an important health services delivery model. Developing a successful and effective program is not a “one-and-done” exercise. It takes effort across the organization and requires constant oversight, monitoring and adjustments over time. As organizations set off on or continue their telehealth journey, a robust data plan is foundational to realizing telehealth’s benefits.